gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Differential treatment of elderly patients with cerebral aneurysms

Behandlungsstrategien von Patienten mit zerebralen Aneurysmen im Senium

Meeting Abstract

  • corresponding author Ulrich Sure - Neurochirurgische Klinik, Philipps-Universität Marburg, Marburg
  • L. Benes - Neurochirurgische Klinik, Philipps-Universität Marburg, Marburg
  • B. Krischek - Neurochirurgische Klinik, Philipps-Universität Marburg, Marburg
  • O. Bozinov - Neurochirurgische Klinik, Philipps-Universität Marburg, Marburg
  • S. Bien - Abt. für Neuroradiologie, Philipps-Universität Marburg, Marburg
  • H. Bertalanffy - Neurochirurgische Klinik, Philipps-Universität Marburg, Marburg

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMO.07.05

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0075.shtml

Veröffentlicht: 23. April 2004

© 2004 Sure et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Both surgery and interventional therapy are used routinely for the treatment of cerebral aneurysms. The treatment of cerebral aneurysms in elderly patients remains challenging, because of their cerebral vascular status (calcifications, tortuous vessels, stenosis) and comorbidity. The present study, therefore, was performed in order to elucidate the decision making process for and against these treatment options in elderly patients.

Methods

The clinical files of 29 consecutive patients (in the 8th and 9th decade of life) with cerebral aneurysms treated at our institute were reviewed. Both the microsurgical clipping and the endovascular treatment are available at our institute. We retrospectively correlated the clinical data (age, sex, localization of the aneurysm, SAH, Hunt & Hess grade [HH]) with the individual treatment decision for any patient and the clinical outcome (Glasgow Outcome Score [GOS]).

Results

Twenty-two female and 7 male patients between 70 and 87 years were treated. Nineteen patients suffered from a SAH, whereas 10 individuals were diagnosed for innocent aneurysms. The aneurysms of 13 patients were treated surgically (coil placement was impossible), 8 patients were coiled, and 8 individuals (mainly with innocent large aneurysms of the carotid artery or with HH grade V) were treated conservatively. Seven patients were lost for follow-up. Of the remaining 22 patients, one individual with HH grade V and conservative treatment died (GOS 1), one patient with a coiled basilar artery aneuryms remained in a vegetative state (GOS 2), 4 patients remained severely disabled (GOS 3) and 16 patients (73%) suffered from a mild disability or recovered fully (GOS 4-5). Six patients whose aneurysms were clipped required a permanent CSF-shunting.

Conclusions

Using a multisdiciplinary aproach, the treatment of cerebral aneurysms in the elderly can be performed succesfully in a high proportion of patients. In our series, the majority of patients (6/10) with innocent aneurysms was treated conservatively. In contrast to elderly patients whose aneurysms were treated endovascularly (0%), those whose aneurysms were clipped had a high chance (46%) for permanent CSF-shunting.